Cypionate Shortage 2026: Why Your TRT Refill Got Weird (and What Your Options Are)

You walked into your pharmacy expecting your usual testosterone cypionate refill, and the pharmacist said one of three things: “we don’t have it,” “we have a different brand,” or “we have a different concentration — call your prescriber.” That’s not your pharmacy being difficult. The U.S. has been working through an on-and-off testosterone cypionate shortage that started in early 2023 and is still on the ASHP and FDA shortage lists as of May 2026.

Here is what’s going on, what your real options are, and why switching formulations is a clinician conversation, not something to improvise.

The American Society of Health-System Pharmacists has listed testosterone cypionate injection as in shortage since early 2023, and that listing has remained active through 2024, 2025, and into 2026. The FDA’s Drug Shortages database mirrors it. Supply has improved versus the worst of 2023, but it has not normalized.

By manufacturer, the picture in mid-2026 looks roughly like this: Pfizer (Depo-Testosterone) 100 mg/mL 10 mL vials and 200 mg/mL 1 mL and 10 mL vials are on extended back order with no firm release date; the 200 mg/mL 1 mL has trickled out in limited weekly allocations. Hikma and Padagis generic testosterone cypionate has generally been available.

In practice: if your prescription was written for Depo-Testosterone specifically, your pharmacy may not be able to fill it, even if a generic testosterone cypionate from another manufacturer is on the shelf. A small change to how the script is written — generic name, alternate concentration — is often the entire fix.

Three forces are stacked.

Demand. U.S. testosterone prescriptions climbed from 7.3 million in 2019 to more than 11 million in 2024, with the steepest growth in men 35–44. Manufacturing sized for the 2019 market is being asked to cover a much larger one.

Schedule III. Testosterone is a controlled substance, so manufacturers cannot simply scale up to meet demand. The DEA sets production quotas, and any increase has to clear regulatory review. The system is designed to prevent diversion; the side effect is that supply does not respond quickly to demand spikes.

Consolidated manufacturing. A small number of facilities produce most of the U.S. injectable testosterone supply. When one of them has a manufacturing delay, the downstream effect is immediate. Pfizer’s Depo-Testosterone delays have been the most visible example.

Switching off testosterone cypionate is not a one-to-one swap. Each alternative has its own half-life, absorption profile, and monitoring rhythm. The formulations a prescriber typically considers:

• Testosterone enanthate — the closest cousin. Long-acting injectable, similar half-life (about 7 days), similar dosing intervals. Also intermittently on the shortage list, but often available when cypionate is not.
• Topical gels (1% and 1.62%) — applied daily to the shoulders or upper arms. Steady-state delivery; no injection. Skin-to-skin transfer to partners or children is part of the prescribing label.
• Transdermal patches (Androderm) — daily patch applied at night. Skin irritation is the most common complaint; Androderm has had its own intermittent supply issues.
• Oral testosterone undecanoate — three FDA-approved products are on the U.S. market: Jatenzo (approved 2019), Tlando (2022), and Kyzatrex (2022). They are absorbed through the intestinal lymphatic system, avoiding the liver-toxicity issues of older oral testosterone. Twice-daily dosing with food. Insurance prior authorization is usually the practical limit, not availability.
• Pellets (subcutaneous) — implanted every 3–6 months. Steady delivery, no self-injection, but the dose is locked in once placed.
• Subcutaneous testosterone — smaller, more frequent doses (often weekly or twice weekly) injected into subcutaneous tissue rather than muscle. Still uses the active ingredient that may be short, but lower per-dose volume can stretch supply.

Every option above is a prescription decision, not a self-managed swap.

Three things tend to matter most when changing formulations.

Half-life and steady-state. Cypionate and enanthate behave almost identically. Gels and patches reach steady state in a few days. Oral undecanoate takes about a week. Pellets peak high and decline. The point isn’t which is better — it’s that the rhythm of your levels changes, which changes how you feel and when follow-up labs should be drawn.

Dose conversion. A weekly 100 mg cypionate IM dose is not interchangeable with 100 mg of anything else. Conversion charts exist, but they are starting points; your post-switch labs are what actually calibrate the dose.

Lab timing windows. With injections, total testosterone is drawn at the trough (the day of the next scheduled dose). With gels, 2–8 hours after morning application. With oral undecanoate, 3–5 hours after the morning capsule. Draw at the wrong time and the number is meaningless — and a meaningless number can lead to a dose change that overshoots in either direction.

This is the layer where DIY swaps go wrong. The vial in front of you may look the same; the prescribing reality is not.

A clinician who is paying attention will confirm with your pharmacy what is actually in stock before rewriting anything, choose the closest-matching alternative for your dosing pattern, and set a follow-up lab window that fits the new formulation.

You should not be stretching doses, splitting vials with friends, or buying testosterone from sources that did not come through a U.S. pharmacy. Counterfeit testosterone in the gray market is a real problem during shortages, and dose accuracy on those products has been documented as wildly inconsistent.

If you’re a Naya patient and your refill is stuck, message us before improvising — Carolyn Pampalone, MSN, FNP-BC, and our NP team can rewrite to whatever the pharmacy actually has in stock, walk you through a switch if one is needed, and set the right follow-up labs. We see patients at our Chatsworth and Santa Barbara clinics and across California by telehealth. The point is to keep your levels and your monitoring intact, not to lose the thread because of a supply gap nobody chose.

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